---
title: "DC 5238 - Spinal stenosis"
diagnostic_code: "5238"
body_system: "Musculoskeletal System"
cfr_section: "§ 4.71a"
canonical: "https://veteranai.co/va-rating-schedule/musculoskeletal/5238-spinal-stenosis"
source: "https://www.ecfr.gov/current/title-38/section-4.71a"
updated: "2026-07-21T19:56:45.536892Z"
---

# DC 5238 - Spinal stenosis

Rated under § 4.71a. Body system: Musculoskeletal System.

General Rating Formula for Diseases and Injuries of the Spine

## Rating criteria

| Rating | Criteria |
| --- | --- |
| 100% | Unfavorable ankylosis of the entire spine |
| 50% | Unfavorable ankylosis of the entire thoracolumbar spine |
| 40% | Unfavorable ankylosis of the entire cervical spine; or, forward flexion of the thoracolumbar spine 30 degrees or less; or, favorable ankylosis of the entire thoracolumbar spine |
| 30% | Forward flexion of the cervical spine 15 degrees or less; or, favorable ankylosis of the entire cervical spine |
| 20% | Forward flexion of the thoracolumbar spine greater than 30 degrees but not greater than 60 degrees; or, forward flexion of the cervical spine greater than 15 degrees but not greater than 30 degrees; or, the combined range of motion of the thoracolumbar spine not greater than 120 degrees; or, the combined range of motion of the cervical spine not greater than 170 degrees; or, muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis |
| 10% | Forward flexion of the thoracolumbar spine greater than 60 degrees but not greater than 85 degrees; or, forward flexion of the cervical spine greater than 30 degrees but not greater than 40 degrees; or, combined range of motion of the thoracolumbar spine greater than 120 degrees but not greater than 235 degrees; or, combined range of motion of the cervical spine greater than 170 degrees but not greater than 335 degrees; or, muscle spasm, guarding, or localized tenderness not resulting in abnormal gait or abnormal spinal contour; or, vertebral body fracture with loss of 50 percent or more of the height |
| 60% | With incapacitating episodes having a total duration of at least 6 weeks during the past 12 months |
| 40% | With incapacitating episodes having a total duration of at least 4 weeks but less than 6 weeks during the past 12 months |
| 20% | With incapacitating episodes having a total duration of at least 2 weeks but less than 4 weeks during the past 12 months |
| 10% | With incapacitating episodes having a total duration of at least one week but less than 2 weeks during the past 12 months |

## Notes

- Note (1): Evaluate any associated objective neurologic abnormalities, including, but not limited to, bowel or bladder impairment, separately, under an appropriate diagnostic code.
- Note (2): (See also Plate V.) For VA compensation purposes, normal forward flexion of the cervical spine is zero to 45 degrees, extension is zero to 45 degrees, left and right lateral flexion are zero to 45 degrees, and left and right lateral rotation are zero to 80 degrees. Normal forward flexion of the thoracolumbar spine is zero to 90 degrees, extension is zero to 30 degrees, left and right lateral flexion are zero to 30 degrees, and left and right lateral rotation are zero to 30 degrees. The combined range of motion refers to the sum of the range of forward flexion, extension, left and right lateral flexion, and left and right rotation. The normal combined range of motion of the cervical spine is 340 degrees and of the thoracolumbar spine is 240 degrees. The normal ranges of motion for each component of spinal motion provided in this note are the maximum that can be used for calculation of the combined range of motion.
- Note (3): In exceptional cases, an examiner may state that because of age, body habitus, neurologic disease, or other factors not the result of disease or injury of the spine, the range of motion of the spine in a particular individual should be considered normal for that individual, even though it does not conform to the normal range of motion stated in Note (2). Provided that the examiner supplies an explanation, the examiner's assessment that the range of motion is normal for that individual will be accepted.
- Note (4): Round each range of motion measurement to the nearest five degrees.
- Note (5): For VA compensation purposes, unfavorable ankylosis is a condition in which the entire cervical spine, the entire thoracolumbar spine, or the entire spine is fixed in flexion or extension, and the ankylosis results in one or more of the following: difficulty walking because of a limited line of vision; restricted opening of the mouth and chewing; breathing limited to diaphragmatic respiration; gastrointestinal symptoms due to pressure of the costal margin on the abdomen; dyspnea or dysphagia; atlantoaxial or cervical subluxation or dislocation; or neurologic symptoms due to nerve root stretching. Fixation of a spinal segment in neutral position (zero degrees) always represents favorable ankylosis.
- Note (6): Separately evaluate disability of the thoracolumbar and cervical spine segments, except when there is unfavorable ankylosis of both segments, which will be rated as a single disability.

# Spinal Stenosis (VA Diagnostic Code 5238)

**Understanding how the VA rates spinal stenosis under 38 CFR § 4.71a.**

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## What Is Spinal Stenosis?

Spinal stenosis is a musculoskeletal condition affecting the spine. For VA disability purposes, it is assigned **Diagnostic Code 5238** and evaluated under the **General Rating Formula for Diseases and Injuries of the Spine**, found in **§ 4.71a**.

Ratings are generally based on how much your spine's range of motion is limited, whether ankylosis (fixation of the spine) is present, and — in some cases — how frequently and severely the condition causes incapacitating episodes.

---

## Available Rating Levels

The VA assigns ratings based on measurable limitations of the cervical (neck) and thoracolumbar (mid/lower back) spine.

### Under the General Rating Formula

| Rating | What the VA Looks For |
|--------|------------------------|
| **100%** | Unfavorable ankylosis of the entire spine |
| **50%** | Unfavorable ankylosis of the entire thoracolumbar spine |
| **40%** | Unfavorable ankylosis of the entire cervical spine; **or** forward flexion of the thoracolumbar spine 30 degrees or less; **or** favorable ankylosis of the entire thoracolumbar spine |
| **30%** | Forward flexion of the cervical spine 15 degrees or less; **or** favorable ankylosis of the entire cervical spine |
| **20%** | Forward flexion of the thoracolumbar spine greater than 30 but not greater than 60 degrees; **or** forward flexion of the cervical spine greater than 15 but not greater than 30 degrees; **or** combined range of motion of the thoracolumbar spine not greater than 120 degrees; **or** combined range of motion of the cervical spine not greater than 170 degrees; **or** muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis |
| **10%** | Forward flexion of the thoracolumbar spine greater than 60 but not greater than 85 degrees; **or** forward flexion of the cervical spine greater than 30 but not greater than 40 degrees; **or** combined range of motion of the thoracolumbar spine greater than 120 but not greater than 235 degrees; **or** combined range of motion of the cervical spine greater than 170 but not greater than 335 degrees; **or** muscle spasm, guarding, or localized tenderness not resulting in abnormal gait or abnormal spinal contour; **or** vertebral body fracture with loss of 50 percent or more of the height |

### Based on Incapacitating Episodes

In some cases, the condition may be rated according to the total duration of incapacitating episodes over the past 12 months:

| Rating | What the VA Looks For |
|--------|------------------------|
| **60%** | Incapacitating episodes with a total duration of at least 6 weeks during the past 12 months |
| **40%** | At least 4 weeks but less than 6 weeks during the past 12 months |
| **20%** | At least 2 weeks but less than 4 weeks during the past 12 months |
| **10%** | At least 1 week but less than 2 weeks during the past 12 months |

---

## How the VA Measures Your Spine

The VA uses standardized ranges of motion when evaluating the spine (see Note 2 and Plate V):

- **Cervical spine (neck):** Normal forward flexion is 0–45 degrees, extension 0–45 degrees, left and right lateral flexion 0–45 degrees, and left and right lateral rotation 0–80 degrees. The normal **combined** range of motion is **340 degrees**.
- **Thoracolumbar spine (mid/lower back):** Normal forward flexion is 0–90 degrees, extension 0–30 degrees, left and right lateral flexion 0–30 degrees, and left and right lateral rotation 0–30 degrees. The normal **combined** range of motion is **240 degrees**.

The combined range of motion is the sum of forward flexion, extension, left and right lateral flexion, and left and right rotation. Each measurement is rounded to the nearest five degrees.

**Exceptional cases:** If factors such as age, body habitus, neurologic disease, or other causes not related to a spine disease or injury make your range of motion normal for you — even if it does not match the standard figures — an examiner may accept it as normal, provided the examiner supplies an explanation.

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## Important Notes the VA Applies

- **Associated neurologic conditions are rated separately.** Any objective neurologic abnormalities — including, but not limited to, bowel or bladder impairment — are evaluated separately under an appropriate diagnostic code (Note 1).
- **Ankylosis definitions matter.** *Unfavorable ankylosis* means the entire cervical spine, entire thoracolumbar spine, or entire spine is fixed in flexion or extension and results in specific complications, such as difficulty walking due to a limited line of vision, restricted mouth opening and chewing, breathing limited to diaphragmatic respiration, gastrointestinal symptoms from costal margin pressure, dyspnea or dysphagia, atlantoaxial or cervical subluxation or dislocation, or neurologic symptoms from nerve root stretching. Fixation of a spinal segment in the neutral position (zero degrees) always represents *favorable* ankylosis (Note 5).
- **Segments are evaluated separately.** The thoracolumbar and cervical spine segments are rated separately, except when there is unfavorable ankylosis of both segments, which is rated as a single disability (Note 6).

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*This information is drawn directly from the VA rating schedule for Diagnostic Code 5238 under 38 CFR § 4.71a. It is provided for general educational purposes and describes the criteria the VA uses. It is not legal advice, and it does not predict or guarantee any outcome.*

Source: https://www.ecfr.gov/current/title-38/section-4.71a